GRAND RAPIDS — The idea that he would be lying with his head bolted to a table — the very thought he would allow a doctor to bore holes in his skull and pierce his brain with wires while he was awake — was more than Parkinson's disease patient Ron Rutkowski could imagine. Yet he had decided to go through with a procedure called deep-brain stimulation that would give him relief from symptoms such as tremors and, perhaps, buy time until a cure is found.

Yet here he was in an operating room at Saint Mary's Health Care, his head shaved and clamped in a metal frame to hold it still. The rest of his body shook violently, not from nerves, but from the Parkinson's disease he at first had denied then tried to control with medication.

"Do you have any questions?" Dr. Steve Klafeta asked.

"No," Rutkowski said. "I'm all set."

A full, active life is interrupted by the onset of Parkinson's at age 43:

A delicate and dramatic surgery offers hope in holding off the disease:

The results give back ground that was lost:

Klafeta made a small incision above the hairline, peeled it open and picked up a drill. It whined, a sound Rutkowski knew well. He had drilled thousands of holes himself, although never into bone.

At 47, he had spent more than half his life building houses, some of the most expensive along the Lake Michigan shore.

Looking back, he knows the Parkinson's symptoms were there, even in his early 40s. He was a workaholic used to 12-hour days, but he would tire easily. His fork sometimes trembled when he ate. He ignored it. Other people got sick, not him. He climbed mountains, jumped out of airplanes, scuba dived and hunted.

Four years before, while hanging a door, he reached for a screw with his left hand, but couldn't pick it up.

"I kinda froze," he said. "I thought I'd had a small stroke."

The next day, he went to his doctor, who sent him to a neurologist in Muskegon. Take this medicine, the neurologist said. If it works, you have Parkinson's.

"That kind of blew me away," Rutkowski said. "I'm only 43 years old and I got Parkinson's? Come on."

Diagnosing it is not a medical certainty based on a blood test or an X-ray. It's a matter of looking at symptoms -- the tremors, slowness, balance difficulties and muscle rigidity -- and ruling out other causes. When nothing else explains it, the diagnosis is Parkinson's.

A Detroit neurologist offered to put Rutkowski on disability.

"I don't want disability," he said. "I want to work. Give me a pill and fix it. There's gotta be someone out there who can fix it. I was looking for a magic cure."

There is no cure, only medication and surgery that can control symptoms.

A Grand Rapids neurologist, Dr. Leslie Neuman, confirmed the diagnosis and warned Rutkowski in five years he would be walking with a cane, maybe using a wheelchair unless he did something soon.

"That's when it sank in," Rutkowski said.

He and his wife, Mary, sat in a restaurant and cried. "All of our plans," he said. "We've got so many things we want to do. We were gonna travel all over, hike. I'd sacrificed so much all my life. I feel bad for my wife and kids, because they've sacrificed a lot, too. It was life-changing."

'Hey, I'm only 47'

Neuman was the first to suggest deep-brain stimulation.

Rutkowski at first would not consider it. "Nobody's drilling holes in my head," he said.

He sat behind a desk in his Norton Shores office in mid-April. As the medication he took minutes earlier kicked in, his head swayed side to side, and his left foot writhed. Most who have seen actor Michael J. Fox assume his uncontrolled movements are caused by Parkinson's. In fact, it is mostly dyskinesia, a side effect of the medication.

How is it done? A surgeon drills two holes in the patient's head and inserts wires attached to a pacemaker-like device implanted in the chest.

Why does it work? That's not clear, but it appears to interfere with abnormal electrical discharges that occur as dopamine declines.

Who may receive it? About 5 percent of Parkinson's patients — those young, otherwise healthy, free of dementia and respond well to medication.

What are the risks? In about 2 percent of cases, bleeding in the brain.

Source: National Parkinson Foundation, www.parkinson.org

He handles sales and marketing and for his company, R.A.T. Construction. Until a few years ago, he sometimes swung a hammer himself.

"There's no way I could do it now," he said.

In the four years since his Parkinson's was diagnosed, the symptoms have worsened. His hands trembled. Sometimes, when he stood, his legs wouldn't move and he would fall on his face. He raised his dosage to 30 pills a day.

At a support group for Parkinson's patients, an elderly man said, "I don't know what we're complaining about. We've had a good life."

"Hey, I'm only 47," Rutkowski said. "I got a lot of life left. It's really uncomfortable, but you gotta keep going. You can't lay down and die."

Normally a people person, Rutkowski began avoiding social situations. For his wife and two daughters, Jennifer and Alivia, it was painful watching his decline. Picking up his granddaughters became difficult.

Mary encouraged him to consider deep-brain stimulation. Only younger, otherwise healthy patients are candidates for it.

Last year, Rutkowski decided to go for it. "I want to have my surgery and live my life," he said.

As the day (May 12) approached, he began feeling the medical equivalent of buyer's remorse. Complications are rare, but bleeding in the brain can occur.

"It's the grip of reality," he said. "I don't want nothing to happen to me that my wife has to take care of me. I worry about my family. If I pass away, I'm totally at peace with it. I'm going to heaven."

'OK, I see your brain'

Off his medication several hours, Rutkowski trembled violently, shaking the hospital bed, causing an IV bag to sway.

"This is me without medicine," he said.

Mary, Alivia, other family members and friends said a prayer, then it was time. In the Saint Mary's OR, nurses and technicians bolted the halo clamped around his head to the table.

An MRI and a CT scan would guide Klafeta, a neurosurgeon and the only Grand Rapids-area doctor performing deep-brain stimulation, to a target the size of a pea. With only a local anesthetic, he drilled a hole about the size of a dime on the right side of Rutkowski's head. Bone dust collected around the bit.

"Can you see my brain?" Rutkowski asked.

"Not yet," Klafeta said. "We're still not sure you have one."

Then seconds later, he added, "OK, I see your brain. You have one."

Using instruments attached to the halo, he guided an electrode through the hole and into the brain. Three clips connected the electrode to a laptop computer, creating squiggly lines on the screen.

Klafeta turned a knob and called out numbers as the electrode penetrated deeper: "Five above, four above, three above ..."

PARKINSON'S DISEASE

An estimated 1.5 million Americans have it, and 60,000 new cases appear each year:

Origin: Neurons begin dying off in the substantia nigra area of the brain. Those cells produce dopamine, necessary for smooth muscle movement.

Mortality: Not fatal, but patients sometimes die of related illnesses.

A sound like rain on a tin roof came from the computer's speakers. It was the subthalamic nucleus, firing signals in Rutkowski's brain. It told Klafeta he was close to the target.

A technician applied an electrical charge, and Klafeta told Rutkowski to move his left ankle, roll his eyes, raise his left arm, open and close his left hand.

"Haven't done that in a while," Rutkowski said. "Did I do good?"

"You did great," Klafeta said.

He repeated the procedure, drilling another hole and inserting an electrode in the left side of Rutkowski's brain, which controls the right side of his body. When Rutkowski was unable to move his eyes, Klafeta repositioned the electrode 2 millimeters, and the side effect disappeared.

"Look at that," he said. "Two millimeters. What kind of tolerances do you have in your home building?"

"One millimeter," Rutkowski answered.

Klafeta closed the holes with a pair of plastic caps and coiled a wire under the scalp. A few days later, he would perform a second surgery, implanting a generator in Rutkowski's left shoulder, attached to the electrodes in his brain.

The generator would remain off a few weeks, a "honeymoon period" during which swelling in his brain would cause his Parkinson's symptoms to decrease temporarily. Then the generator would take over.

'Oh, man, am I ready'

Rutkowski knows the deep-brain stimulation is not a cure, but a way of buying time, setting back the disease maybe five years. The death of brain cells will continue, eventually forcing him to up his medication.

He and Mary hope by then researchers find a cure, maybe through gene therapy or stem cells.

"Especially when they give you a disease with no cure, you need hope," Mary said.

A few weeks after surgery, she and Ron returned to Saint Mary's. The honeymoon was over; trembling and muscle freezing were back.